Glitches Threaten ACA Coverage for Some Immigrants

After receiving help from an Arabic translator, Iraqi refugee Mohammed al Mamoori signed up for health insurance through the federal marketplace in March and says “he’s now on the safety side” of life in America. But he faces an upcoming deadline that could leave him without health insurance unless he is able to verify his citizenship status.

In July, al Mamoori, a delivery driver who is designated as a permanent resident, was among the hundreds of thousands of individuals across the country who received letters from the U.S. Department of Health and Human Services asking for proof of their citizenship or immigration status.

He has since uploaded documents to healthcare.gov to prove his residency. But with a fast-approaching Sept. 5 deadline, al Mamoori said he has not received any confirmation from federal officials that his citizenship has been verified and is uncertain whether he will retain his coverage next month.

The outstanding notices highlight the challenges of signing up individuals who have recently become U.S. citizens or permanent residents. Texas is home to a large immigrant population, particularly from Mexico and Central America, and takes in thousands of international refugees every year.

Health advocates helping the state’s minority population say they’ve been working to overcome language barriers, technical issues and low awareness of who is eligible to obtain coverage under the federal health law. With the first enrollment period closed, enrollees are now dealing with inconsistencies in their applications, which are detected when the marketplace website finds a data matching issue between the reported citizenship information and the information the government has on file for an individual.

Throughout the summer, HHS has resolved thousands of these inconsistencies. But last week, 52,700 Texas residents received final notices that they still need to verify their citizenship status — the highest count of final notices for any state except Florida.

In the Rio Grande Valley, individuals who became permanent residents in the last few years encountered difficulties during the application process on healthcare.gov after the marketplace did not recognize their permanent resident card numbers, said Cliff Clark, the director of Migrant Health Promotion Salud’s navigator program.

Clark’s team, which works with a mostly Hispanic population, has helped individuals resolve some of those problems by mailing copies of permanent resident cards to HHS.

But even after completing their applications and obtaining coverage, some individuals received additional inconsistency notices in the mail this summer for the same issues.

Clark said at least seven out of every 10 cases involving immigrants who recently became permanent residents or naturalized citizens or have families with mixed citizenship status have encountered snags verifying their identities and citizenship status.

“It’s probably more. I think I’m being a little conservative, but there have been some pretty heavy issues for that group of folks,” he said.

While the disparities do not indicate that enrollees are ineligible for coverage, their insurance will be cut off on Sept. 30 “to ensure program integrity and protect taxpayer dollars” if they do not provide the requested documents, according to HHS.

Senior health officials said the enrollees were instructed to submit their supporting documents by uploading them to the marketplace website or mailing them in. But Elizabeth Colvin, director of Foundation Communities’ Insure Central Texas program, said several individuals her group worked with had experienced technical difficulties with the website and have been unable to upload documents.

"You have to upload information to prove you are who you say you are, but that upload feature didn't always work in the website," Colvin said, adding that 50 percent of the people her team works with speak only Spanish and many of the others are refugees who live in Austin. "Sometimes the documents were received, sometimes they just got lost."

HHS officials said enrollees who have sent supporting documents to verify their citizenship status are supposed to receive a letter from the marketplace confirming that their inconsistency will be cleared.

But health advocates said individuals who have mailed copies of their documents to an address specified by HHS have not received any sort of confirmation notice and remain unaware of their current status.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.